A/HRC/41/34/Add.1 health. To be effective, primary care must be supported by mental health specialists working as consultants at the outpatient and day-care levels. However, these services, with some exceptions in larger cities, are not available to the majority of persons who need them. The field of child and adolescent mental health is particularly underdeveloped, with only a few specialists working in this important field in the two largest cities. 60. The Special Rapporteur was informed about the issue of adolescent suicide, a sensitive issue of increasing concern that is linked to religious and cultural beliefs and therefore largely underreported. Death as a result of suicide is sometimes disguised as having had another cause. Consequently, the data available on the issue differ from source to source, even though there is a general consensus that the suicide rate among adolescents is increasing, and that the rate among young men is higher, but is increasing at a faster pace among girls. 61. The Special Rapporteur emphasizes that child and adolescent psychiatry is an established medical specialty and that it should be developed in Kyrgyzstan to address adolescent suicide and other child and adolescent mental health issues. Furthermore, services for children and adults with intellectual and psychosocial disabilities, which mainly require non-biomedical interventions, should be developed at the community level. Autism is an excellent example of a condition that cannot be effectively addressed through the biomedical model. Children and adults with autism face barriers that should be removed through a broader approach, which involves health, education and social services and a good level of cooperation between those three sectors. 62. A comprehensive long-term strategy ought to be developed in order to lower and eventually eliminate reliance on large, segregated institutions, including psychiatric hospitals and residential institutions. At the present time, Kyrgyzstan does not seem ready to order an immediate full closure of all such institutions, which is why they should provide at least the minimum conditions to protect the dignity and human rights of the persons living in them. At the same time, capacity at community-based centres should be built and strengthened to eventually care for those currently living in institutions. Throughout this process, independent mechanisms should continue to monitor institutions to ensure that they provide decent conditions to allow children and adults to live in dignity, with no space for abuse or violations of their human rights. 63. National and international investments in health and social care should start to be directed, as a priority, at the establishment and strengthening of community-based outpatient services that effectively serve the particular mental health needs of persons in the communities in which they live. The Special Rapporteur was informed by the relevant authorities about two government-led investment initiatives to improve the premises of two psychoneurological institutions, one of which he visited. Although the management team at the Belovodsk psychoneurological institution is working well to address the needs of the children through improved facilities and qualified and committed staff, the Special Rapporteur stresses that the ultimate responsibility of promoting and protecting the rights of persons with intellectual, cognitive and psychosocial disabilities lies with the State. 64. A long-term vision requires investment, as a priority, in community-based services, with a family-focused approach to services for children in need. The health, social welfare and education sectors should develop early intervention services for children with disabilities and their families, inclusive education in schools and child mental health services at the community level. The same principle applies to the development of mental health services for adults, including older persons. 65. Such a long-term vision requires a move away from excessive reliance on institutional care and treatment with psychotropic medication. Mandatory health insurance must cover psychosocial interventions, as they are equally as needed and effective as medication. As a recent WHO study23 revealed, such a strategy requires close collaboration 23 12 See WHO Regional Office for Europe, Mental health, human rights and standards of care: Assessment of the quality of institutional care for adults with psychosocial and intellectual disabilities in the WHO European Region, 2018.